<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN"
 "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">

<head>
    <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"/>
    <title>Web Form</title>
    <script src="../raxan/startup.js" type="text/javascript">/scripts/-/</script>
    <style>
    .impress {
    	background: #DDE8AE;
    	border: 1px solid #fff;
    	border-left:2px solid #C6D880;
    	border-top:2px solid #C6D880;
    	padding:5px;
    }
    </style>
</head>

<body>
    <div class="container c30 hlf-pad lightgray">&nbsp;<a href="index.html" title="Back to the Examples Web Page"><img src="images/arrow_left.png" width="16" alt="Menu"/> Examples</a> | Raxan Framework&nbsp;</div>
    <div class="container c30 tpm">

        <h2 class="bottom">Customer Profile</h2>
        <hr />
        <form id="frmStudent">

			<div class="success c23">
				<h4 class="box-title">General</h4>
				<div class="pad clear">
					<div id="pnlError" class="alert bmm hide clip">
						The following fields are required:
					</div>

					<div>
						<label class="left">First Name:<br /><input id="txtFName" name="txtFName" type="text" size="30"  /></label>
						<label class="left ltm">Last Name:<br /><input id="txtLName" name="txtLName" type="text" size="30"  /></label><br />
						<label class="left">Street:<br /><input id="txtStreet" name="txtStreet" type="text" size="40"  /></label>
						<label class="left ltm">City:<br /><input id="txtCity" name="txtCity" type="text" size="20"  /></label><br />
						<label class="left">State:<br />
						<select name="lstCountry" class="c8">
							<option>Brazil</option>
							<option>Canada</option>
							<option>France</option>
							<option>Jamaica</option>
							<option>United States</option>
							<option>United Kingdom</option>

						</select></label>
						<label class="left ltm">State:<br /><input id="txtState" name="txtState" type="text" size="20"  /></label>
						<label class="left ltm">Zip:<br /><input id="txtZip" name="txtZip" type="text" size="11"  /></label>
					</div>

					<hr class="space" />

					<div class="impress" align="right">
						<strong>Contact Via: </strong>&nbsp;
						<label><input name="chkFeatures" type="checkbox" value="phone" /> Phone</label>&nbsp;
						<label><input name="chkFeatures1" type="checkbox" value="email" /> Email</label>&nbsp;
						<label><input name="chkFeatures2" type="checkbox" value="fax" /> Fax</label>&nbsp;
					</div>
					<div class="clear"></div>
				</div>

				<div class="hlf-pad " align="right">
					<div id="status" class="left"></div>
					<input id="btnSave" class="button process" type="button" value="Save" />&nbsp;
					<input id="btnCancel" class="button cancel" type="button" value="Cancel" />
				</div>
			</div>

        </form>

    </div>

</body>

</html>
